ACCESSING HEALTH CARE
Growing up, my dad had a stable teaching job with state health benefits. And with my doctor/uncle living next door, my family had few run-ins with illness that couldn’t be attended to by heading next door when Uncle Kim’s Jeep pulled up in the driveway.
When I was five years old, I went into his small office for x-rays after breaking several bones in my right foot while jumping off the stairs at my best friend’s house. I remember taking our family dog to the same x-ray machine when she broke her foot after underestimating the height of a cliff she jumped down.
Access to health care was never a big deal for me or our pets. It wasn’t until years later, as I traveled with my family and witnessed poverty and poor health across several continents, that I was exposed to the privileged care I took for granted as a child. I realized that we have amazingly advanced technologies and health care here in the U.S. But it wasn’t until years after my traveling experience, that I realized it wasn’t my advantage as an American that provided my healthy life, but the fact that for me, and a fraction of the U.S. population, access to health care is relatively straightforward and an easily attainable commodity.
The uninsured, make up 16 percent of our nation’s population, and as the number continues to grow, changes to the system feel imminent.1 For the millions of Americans who live without health care, it is a big deal. The barriers are many and varied. Walking through the complicated maze of our health care system is confusing at best, even for those who have insurance, speak English, and have the education to maneuver through the system. As health care costs continue to rise, as premiums continue to increase, and as small businesses find it increasingly difficult to provide employment-based insurance for their employees, we are on the precipice of change.
I work for a tiny health access program that on a very local level tries to fill the gaps in availability to the low-income and uninsured, so my perspective on the system is certainly biased. I work with amazing health care providers who have sworn oaths to provide quality care and whose edicts include providing care regardless of ability to pay. But these generous providers can only see patients for free on a limited basis and only while they are compensating the free care with paid claims. With Medicare helping the aged, and Medicaid helping some of the poorest members of our communities, there are still many gaps in the system and many people who go without coverage. For some, the emergency room feels like the only option for care, and this is both costly and usually ineffective.
As the 2008 Presidential Campaign rolls on, the polling numbers continue to show that health care is a significant issue for many voters. This issue focuses primarily on one’s ability to access health care, not on the quality of the health care. Current legislation is seeking to address some of these problems on both a state and national level, and both the state and the nation are looking for alternative systems and means of providing health care.
The Massachusetts Plan to require health insurance for all residents was an innovative way to tackle the problem on a statewide level. Hawaii and Maine have adopted plans that provide coverage on a near-universal level, and many other states are working on plans to cover more children and, in some cases, more adults.
On a national level, the State Children’s Health Insurance Program (SCHIP) has been getting frequent media coverage, as it is up for reauthorization this year. SCHIP offers health care coverage (including dental and mental health) to children of low- to moderate-income-level families. Six million children in the nation receive these benefits; however, forty thousand children in Utah are uninsured, and across the nation uninsured children are numbered at 9.4 million.2
As an undergraduate, I studied anthropology. I loved studying about people and culture, and the new lens that came with these discoveries allowed me to see the world in a whole new way. I loved the adventure that came along with studying—the new lands and languages; the new customs and foods. I wanted to learn about people from across the globe, study their lives and culture, and help find a way to reverse the damages caused by hundreds of years of imperialism and colonial rule. I felt that studying anthropology would give me the framework for understanding others, and that studying international development would give me the tools to undertake the “help” part of the equation. I envisioned rolling up my shirtsleeves and digging into the dirt of international relief and development with my shovel of cultural competency.
During my senior year at BYU, I completed a field study in Guatemala through the Kennedy Center. While in Guatemala, I researched the affects of outside development agencies on the structure of local governance and on building a new physical community. The more I watched, and the more I thought about lessons I learned from my sustainable development courses, the more I wondered about my actions, and how they were affecting those around me. I watched my idealism crumble into a pile of cynicism as I experienced the subtleties and sensitivities that had to be considered while working across cultures, especially in someone else’s country telling “them” how “they” should improve “their” lives.
AS HEALTH CARE COSTS CONTINUE TO RISE, AS PREMIUMS CONTINUE TO INCREASE, AND AS SMALL BUSINESSES FIND IT INCREASINGLY DIFFICULT TO PROVIDE EMPLOYMENT-BASED INSURANCE FOR THEIR EMPLOYEES, WE ARE ON THE PRECIPICE OF CHANGE.
I realized that even as a mere field study student researching in an isolated town, I was affecting the lives of those around me. I had heard the horror stories of humanitarian aide: a village that got tractors they couldn’t maintain; a rural community’s egalitarian social structure being disrupted by an unsuspecting, well intended outsider building greenhouses in one neighborhood and not another; the dam that saved one destitute village but destroyed the downstream neighbors . . . and the stories went on.
Armed with my cultural competency training, anthropological background, and good intentions, I naively assumed I was ready to repair the world. During my field study, I began to wonder if the nature of my “fixing” the world’s problems wasn’t itself perpetuating the problem of ethnocentrism. Where do the boundaries lie? How do we know who we are obligated by history to help, and who we are obliged to allow to create a better future for themselves? I backed off, but I still wanted to “help,” so I started to look for opportunities a little closer to home, where I could avoid the moral dilemma associated with the guilt I felt to do something, balanced against the fear that I was really only helping myself.
1. U.S. Census Bureau. 2006, http://www.census.gov.
2. Kaiser Commission on Medicaid and the Uninsured. 2007 Fact Sheet, http://www.kff.org/uninsured/upload/7698.pdf.
MANAGEMENT EDUCATION IN SWITZERLAND
In Switzerland, the state dominates higher education. Most Swiss students graduating from high school stay in Switzerland to further their university training. Generally, Swiss universities have either free or very low tuition rates for Swiss nationals. It is quite rare to hear of students continuing their studies in France or Germany.
As a professor at the International Institute for Management Development (IMD) in Lausanne on Lake Geneva in Switzerland, I have had the opportunity to interact with and teach students from various backgrounds. IMD is a private, nonprofit institute with fifty-two full-time professors from thirty-one countries and is consistently ranked either number one or two in the world for our executive programs.
In 2007, the Wall Street Journal ranked IMD the number two MBA program worldwide. While IMD’s MBA program consistently ranks in the top ten in the world, our real focus is on executives. (Over 90 percent of our revenue comes from executive programs.)
A major difference between IMD and other business schools is we do not have a tenure system. To my knowledge, we are the only top-ten school without tenure. Most of our faculty gladly gave up tenure and, in some cases, academic chairs to teach at IMD. (Of course our faculty also have the reputation of being well compensated for their work.) We have a very performance-oriented culture—no one is resting on their laurels. As a result, IMD is a place filled with hustle, vibrancy, and cutting-edge, real-world thinking.
We place high emphasis on a multidimensional view of business and life-enhancing learning experiences. IMD is a modern and high-tech establishment. Many of our programs rely on case studies, video, and the like. Our Executive MBA program includes a large amount of Internet-based assignment work and virtual teamwork. Every year, over eight thousand executives from every country in the world come to IMD’s Lausanne campus for a wide array of programs, including company-specific programs and open programs.
IMD is a unique campus in that the student body represents over ninety-eight nationalities. I am currently running an executive program with participants from the following countries: Germany, France, Switzerland, Japan, Italy, Netherlands, UK, Brazil, Philippines, Australia, Russia, Denmark, Spain, U.S., Argentina, etc.
Our students are perhaps the most international-minded and experienced student group you could find anywhere in the world. It would not be much of an exaggeration to say that 100 percent of our students speak at least one foreign language. Everyone who attends has lived and worked internationally for all or part of their careers. International experience is an essential prerequisite for studying at IMD and a lack of international experience will prevent you from being accepted into the MBA program. The invariable exceptions are the Americans who attend our programs. Generally, they are the least international-minded of our participants. I think that one of the reasons IMD appeals to Americans is the international mix of IMD’s participants and faculty. Americans want the decidedly non-American experience that IMD has to offer.
IN MOST COMPANIES, THERE ARE TOO MANY WHO ARE COMFORTABLE FOLLOWING AND NOT ENOUGH WHO ARE COMFORTABLE—AND COMPETENT—LEADING.
As a faculty member, I also benefit from the diverse student body that is drawn to IMD. In a typical year, I will work with about five hundred different executives from a wide range of companies. Much of this work is customized for teams of managers from the same company. These companies might include E&Y, Akzo Nobel, or Toshiba. Each has its unique set of issues and challenges, but they also share some common concerns. A chief concern is how to globalize what are often very country-centric subsidiaries. Another concern is how to strengthen and deepen their management bench-strength. In most companies, there are too many who are comfortable following and not enough who are comfortable—and competent—leading. Leading in a global world is very challenging.
This requires being out “there” constantly—pulsing global markets and clients and interfacing with employees around the world. And it isn’t just the wear and tear of travel that is required. There is intellectually tough work to stay on top of the often conflicting tensions and complexity inherent in global business. As a result, many would be more comfortable staying at home and not stretching themselves.
One of the things I like best about my job is the ability to transfer what I learn working with companies back into the classroom. I interview senior executives and am constantly working on materials for different programs. Right now I am writing up three different case studies that I will use in the classroom. They involve real-life situations—some tell inspiring stories, others talk of mismanagement and poor decision making. All play critical roles in advancing the practice of management.
My interest in international business was heavily influenced by my mission in Paris, France, for the Church. The time I spent in France gave me the international bug, and it has never left. After my mission, I earned an undergraduate degree in international relations from BYU. My studies at BYU were an incredible experience, and I had the most wonderful professors. After my time at BYU, I went on to complete my MBA in Canada, and then earned a PhD in international business from the University of South Carolina (arguably the top PhD program in international business in the country). I can safely say that I have been well trained in international business issues.
After my PhD, I joined the Ivey Business School in Canada, the oldest business school in Canada with a top reputation. After three years, I moved to Arizona where I was promoted to first associate professor and then full professor of international management. I was also the head of the International Management Department. After six years in Arizona, I returned to the Ivey Business School, where I was a full professor and head of the Bombardier Chair of Global Management. I also served as associate dean of Executive Development.
During my six years in Canada, I was enticed to come to Switzerland to join IMD. My family and I have been here for three and a half years. Living in Switzerland has been a great experience for me and my family.
While formal education is one thing, it is quite another to stay abreast of what is happening in the world today. Much of what I learned twenty years ago in my PhD is now old news. You have to keep learning and embracing new ideas, new ways of thinking. Formal education is the easy part.
U.S. FOREIGN SERVICE AND DEVELOPMENT ASSISTANCE
As an auditor of U.S. foreign assistance for nearly two decades, I have seen some dramatic changes take place—particularly during the last few years. I am currently managing an office of eight auditors and two investigators based in Baghdad covering U.S. Agency for International Development (which forms one of the more appropriate and memorable acronyms in the federal government—USAID, or simply AID) reconstruction efforts in this war-torn country. As this is an unaccompanied post, my family has remained in the U.S.
After several years of administering large contracts to help rebuild and modernize Iraq’s infrastructure, USAID has now shifted toward programs to build the capacity of Iraqi national, provincial, and local governments to enable them to provide essential services to their citizens. Such programs are designed to help stabilize communities by providing enhanced security, employment, education, and economic opportunities.
A new tool that USAID has been using to better reach communities throughout Iraq is called the Provincial Reconstruction Team (PRT). PRTs are a joint civil and military effort, and they are the primary interface between the U.S. government and provincial Iraqi governments. There are currently about two dozen PRTs located in cities such as Basrah, Mosul, Irbil, Falluja, Kirkuk, and Najaf. About half of the PRTs are embedded with U.S. military troops in Forward Operating Bases (FOBs). Coalition partners and other countries also participate on the PRTs. In fact, three PRTs are led by the UK, Italy, and South Korea.
My career began in the Office of Inspector General for USAID. USAID’s history goes back to the Marshall Plan which was put in place to help reconstruct parts of Europe after World War II. In 1961, the Foreign Assistance Act was signed into law and USAID was officially created by executive order. Since that time, USAID has been the principal U.S. agency to extend assistance to countries recovering from disaster, trying to escape poverty, and engaging in democratic reforms.
My first assignment with USAID was based in Cairo, Egypt, where I spent eight of the next ten years auditing the agency’s programs and operations in Egypt, as well as other countries in the Middle East. The majority of my time was spent in Egypt since that’s where a large portion of U.S. foreign assistance was directed. Based on the 1978 Camp David Accords and the Israel/Egypt Peace Treaty signed the following year, Egypt received nearly one billion dollars of U.S. nonmilitary aid on an annual basis. During the 1980s, only Israel received more foreign aid from the U.S.—but Israel’s aid was a cash transfer whereas Egypt’s was programmed, administered, and audited by USAID. At that time, USAID was principally funding agricultural, educational, economic, and local government programs, as well as some large water/wastewater infrastructure projects and a commodity import program.
Nancy, my wife, and our five children under the age of nine, accompanied me to Cairo. While in Egypt, two more children were born giving me the honorific Arabic title of Abu Saba’a (Father of Seven). Our children attended Cairo American College, a K–12 international school near our home in Ma’adi—a suburb of Cairo. We enjoyed attending the Latter-day Saint Cairo Branch which fluctuated between fifty and one hundred mostly expatriate members, who met in a rented villa on Fridays—the Muslim holy day. While in Egypt, we also made trips to BYU’s Jerusalem Center a number of times.
After Egypt, I spent a few years at USAID headquarters in Washington, D.C., until being assigned to Pretoria, South Africa, as Regional Inspector General. During our stay in South Africa, our family continued to shrink in size as the older children went to college and got married.
GETTING FOREIGN SERVICE OFFICERS TO WORK OUTSIDE OF MAJOR CAPITAL CITIES IS AN IMPORTANT COMPONENT OF THE STATE DEPARTMENT’S NEW TRANSFORMATIONAL DIPLOMACY. . . .
For the next four years, I managed an office that provided audit and investigation services for USAID programs in more than twenty countries in southern and eastern Africa. The main area of focus in that region was health—including prevention and treatment programs for HIV/AIDS, malaria, and tuberculosis. We spent a lot of time and resources auditing components of President Bush’s five-year, fifteen billion dollar Emergency Plan for AIDS Relief announced during his State of the Union address in 2003. We also audited reconstruction projects following massive floods in Mozambique and Madagascar, as well as humanitarian assistance efforts in Angola and Sudan following the end of long-standing civil wars in those countries. Following another stint in Washington, D.C., I volunteered to serve my current one-year assignment in Iraq.
Getting Foreign Service officers to work outside of major capital cities is an important component of the State Department’s new transformational diplomacy, designed to help build and sustain democratic and well governed states that respond to the needs of their people and conduct themselves responsibly in the international community. As part of that effort, development has joined diplomacy and defense as the three “Ds” or principal elements of U.S. foreign policy.
As stated by Secretary Condoleezza Rice in January 2006, “The resources we commit must empower developing countries to strengthen security, to consolidate democracy, to increase trade and investment, and to improve the lives of their people. America’s foreign assistance must promote responsible sovereignty, not permanent dependency.” I am proud to have contributed a small part toward the accomplishment of that worthy goal.
My interest in countries beyond America’s borders began with a call to be a missionary in Central America in the mid-1970s. It was my first time to be outside of the U.S., and I enjoyed learning a new language as well as experiencing new cultures. This led to a post-mission BA in international relations with a minor in Spanish from BYU. Unfortunately, the David M. Kennedy Center for International Studies had not yet been established. However, I did participate in BYU’s Washington Seminar program which allowed me to work and study in Washington, D.C., for a semester. My faculty advisor was Dr. Stan Taylor, and I also remember getting a lot of advice and encouragement from Dr. Ray Hillam, both of whom are former Kennedy Center directors.
Although I missed out on the full Kennedy Center experience, the center adopted me upon its opening in 1983, and I have managed to keep in touch with the center throughout my professional career. Through the years the Kennedy Center has provided me with transcripts of many of its interesting presentations and forum discussions. My family was featured in one of the center’s publications on U.S. expatriates living abroad, for which we received a complimentary set of the early CultureGrams.
After receiving an MBA from BYU, I became an auditor in the Office of Inspector General for USAID. And so began my two decades with the U.S. Foreign Service.